| NPI | 1154642791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: UT 5115898-1204) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2013012534) |
| Enumeration Date | 2010-06-17 |
| Last Update Date | 2016-07-05 |